Medium-term efficacy of the prostatic urethral lift

Abstract

Treatment options for patients with benign prostatic hyperplasia have traditionally revolved around pharmacotherapy or invasive surgery, both of which can negatively impact quality of life (QoL). The quest for a suitable minimally invasive surgical therapy as an alternative to long-term medication or conventional surgery, has seen the development of heat-based therapies, most of which have been dismissed because of post-operative complications and unacceptable re-treatment rates. During the late 1980s and 1990s, mechanical approaches such as transurethral balloon dilation and prostatic urethral stenting were investigated; however, re-treatment rates, encrustation and unacceptable migration rate of stents saw these options fall into disuse. In 2004, a new non-thermal, mechanical approach-the Prostatic Urethral Lift (PUL; UroLift^®, NeoTract Inc., Pleasanton, CA, USA) was first investigated as a minimally invasive therapy for men with lower urinary tract symptoms (LUTS) secondary to BPH. A randomised "sham"-controlled clinical trial of PUL commenced enrolment in 2010. Results of 4-year follow-up have recently been published. This paper reviews these results, the latest literature on PUL and places them in perspective with regard to the proposed criteria for the optimal minimally invasive approach to treating LUTs in men with BPH.

Keywords: Benign prostatic hyperplasia (BPH); lower urinary tract symptoms (LUTS); minimally invasive surgical procedures.

Figure 1

Urolift components. (A) The Prostatic Urethral Lift system endoscopic materials consisting of a 2.9 mm telescope designed to fit within the dedicated UroLift delivery system. The UroLift delivery system is accommodated with a standard 20Fr endoscopic sheath; (B) the UroLift implant consists of a nitinol (nickel-titanium alloy) capsular tab, paired with a stainless steel urethral endpiece which are joined and tensioned along a length of monofilament suture (polyethylene terephthalate). CT, Capsular Tab; M, Monofilament suture; U, Urethral anchor. (Image courtesy of Neotract, Inc.).